How mothers in Malawi have completely transformed the fight against HIV

Brenda Kayuni is one of those people who fills the room as soon as she enters it.

Poised, elegant and expressive, she takes the lead in our conversation as she recites a speech about how she has saved the lives of many children and mothers in rural Malawi.

She is not a trained health professional, or an aid worker from outside the country or a government bigwig, but Kayuni is saving lives because she meets the following criteria: she is a HIV positive woman who has given birth to HIV negative children.

When I chipped in at the end of her verve, I said that I might have one or two more questions to ask about her work.

“Well yes, I expected as much,” she laughed.

Kayuni is a “mother buddy” in her community in Kamwe, in rural Malawi. Travelling anywhere from 10 to 90 minutes away to visit expectant mothers and named clients, she is a voluntary worker as part of a Tearfund project that combats the risk of passing HIV onto babies.

A mother buddy explains her role in the project

The mother buddies, who are all HIV positive women who have given birth to HIV negative babies, assist neighbouring mothers-to-be who are at risk of passing on the immunodeficiency virus to their children.

Appointed by village leaders across communities in rural Malawi, the women are given a smartphone to log and track their clients’ progress, in which they record their health details over eight visits to the mother, which start in the first three months of the pregnancy, right through to when the child is two years old.

Using a smartphone app and their training from a local charity named LISAP, a charitable group which works in sponsored_longform with Tearfund to halt the spread of HIV, the buddies inform mothers of how to avoid spreading the virus to their newborn.

Providing key information about how to prevent the spread of the virus, the mother buddies are an essential diplomat between the mother-to-be and local hospitals.

During the visits, partners are informed that they should abstain from extra-marital sex and rest during pregnancy (too much work could compromise their immune system and make it more likely for them to contract HIV during intercourse). They are also told to eat from six key food groups to ensure that they and the baby are getting the nutrients that they need.

The mother buddies also encourage the mothers-to-be to give birth in hospital, rather than at home. Most prefer to give birth at home because the health centres are so far away, but the mother buddies inform these women that due to the trauma of birth, many babies could cause a tear in the womb due to stress and movement, which would mean that their blood would be infected with HIV. Therefore it is safer for them to give birth in hospital.

“The first one is to reduce the spread of HIV. The second one is to reduce maternal death, particularly in those who are HIV positive. The third one is to reduce infant mortality, while the fourth is to increase male involvement in issues in maternal health, particularly men attending antenatal clinics,” she explains.

Prior to the project, those nuggets of information about ante-natal health that we take for granted – such as resting during pregnancy and eating food with high nutritional value – were not widely known in the area. Ante-natal visits to the clinic were carried out in a low-key fashion by pregnant women in communities such as Kamwe, and fathers-to-be rarely attended the check-ups with their partners.

Mother buddy Dorothy with her client Roshiko and her healthy baby daughter

By using the phone, which contains information on the importance of eating a good diet, getting plenty of rest, having frequent hospital visits, and using mosquito nets to eliminate the ever-present additional risk of Malaria, hundreds of women can access information in rural, hard-to-reach areas of the country.

A mother buddy called Dorothy Kapesa takes me through the phone’s settings. We’re sat with her client Yvonne Kilembe, and the pair are playing with Yvonne’s baby girl, who is HIV negative – thanks in no small part to the programme.

“In the past, I wasn't educated as far as HIV and AIDS were concerned,” says Kapesa.

“I have a 12-year-old child who is HIV positive, because I didn't have the education that I have now. So I decided, no, I need to make sure I am supporting my fellow women, so that they can avoid it,” she says.

“I was pregnant, but I didn't know,” adds Kilembe. “Then they checked my blood and told me I was HIV positive, and the mother buddy came in and started advising me. I felt bad when I was told I was HIV positive but since Dorothy’s visits, I feel positive, I feel encouraged.”

Mother buddy Dorothy with client Yvonne

Operating in rural areas across the country is key to the project’s success.

“None of the bigger charities really go there to help. The bigger charities tend to keep their work to the towns, because they look at how inhospitable the terrain is, and the lack of roads, and think, we cannot reach it.”

Now, thanks to the programme, the risk of mother-to-child HIV transmission has been cut from 10% to 3%.

Prior to HIV medication entering Malawi in 2001, alarmingly high rates of the outbreak meant that 30% of the population were infected with HIV, and a diagnosis was a death sentence.

Mphatso, one of the creators of the mother buddy project

“Women with HIV were treated like lepers at the peak of the outbreak,” says the former director of the mother buddy programme, Mphatso Ngulube.

“They would have a separate cup and bowl, and could be denied a blanket or even food. They were left to die,” she adds.

Thanks to the involvement of the mother buddies, not only are more women giving birth to HIV negative children, but they are also alerted to the condition before it evolves into life-threatening AIDS.

Plus, more pregnant women are visiting antenatal clinics with their husbands, where both partners can get tested and receive antiretroviral drugs (ARVs) to manage their condition.

And although husbands in the communities are increasingly involved in their wives’ wellbeing during pregnancy, it is clear that the bonds between mother buddy and client provide a unique and heartening guardianship.

“When I first found out I was HIV positive, I felt so depressed,” says Kilembe. “I started the ARVs, but then I stopped, because of that depression. But when the mother buddy came in, I picked the tablets up, and started again. And from that moment, we have been so close.”

Mother buddies in Kamwe

But in the case of Priscilla Munkhonza, the mother buddy has filled the shoes of her partner.

After being abandoned during the first few months of her sixth pregnancy, the tomato farmer was left to raise her family alone and feared for their survival.

"A lot of things change when your husband leaves you. You need to find out where that support is coming from and I was scared,” she explains.

“My mother buddy came and said don't be worried about your husband, we'll give you the support that you need, even after the baby is born. I want my baby to be a nurse, because it's such a supportive job.”

At the end of the working day, the mother buddies can often be seen waiting on one of their colleague’s steps, sharing tales in a cacophony of bike bells, laughter and voices.

And as a client or two sit on the steps with their guardians, it becomes clear why the project has become such a roaring success.

Speaking to two of the women chatting, I ask what life means for them now that their final visit is over.

“We are still going to chat, but now as friends, as people who know each other. But the health stuff stops here. Now with the child, she has graduated from the mother buddy programme,” says the mother buddy.

“It's such a good story in my life. She has taught me things that I didn't know, so it is a wonderful story to tell,” says the client.

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Jasmine Andersson

When she isn't talking about her emotional attachment to meal deals or serenading unfortunate individuals with David Bowie power solos in karaoke booths, Jasmine writes about gender, politics and culture as a freelance journalist. She wastes her days tweeting @the__chez